World Journal of Surgery

, Volume 29, Issue 8, pp 962–965 | Cite as

Selective Conservatism in Trauma Management: A South African Contribution

  • D. L. Clarke
  • S. R. ThomsonEmail author
  • T. E. Madiba
  • D. J. J. Muckart

Trauma in South Africa has been termed the malignant epidemic [1]. This heritage was the result of a violent colonial legacy [2] which spawned the apartheid system of injustice and the struggle against it [3,4] The Apartheid regime created overcrowding, unemployment, social stagnation, and the disruption of normal family life. These were the catalysts for the incredible amount of criminal and interpersonal conflict in South Africa over the last 50 years. African townships such as Soweto in Johannesburg and Umlazi in Durban were crime-ridden ghettoes where the apartheid police were more interested in fueling the “black on black” violence rather than trying to curb it. Baragwanath (Chris Hani-Baragwanath) and King Edward the VIII Hospital in Durban were the “trauma care epicenters” on the fringes of these huge urban conurbations. Both were designated black hospitals and both were underfunded and dilapidated. Even the architecture was similar, with prefabricated, poorly ventilated...


Damage Control Stab Wound Esophageal Injury Pancreatic Trauma Firearm Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors thank the “ordinary people” victims of apartheid who became our patients and allowed us to develop these surgical skills and write about them. The authors have had the privilege to work with individuals who ran with the concept in the early years, built on it, and allowed us to continue to run with it. They are Professors Baker, Angorn, Robbs, and Mr. Luvuno, from Durban, and Professors Demetriades, Pantanowitz, Mr. Stein, and Mr. Rabinowitz from Johannesburg. These are not the only institutions or individuals dealing with trauma in South Africa, and others in the country have made many significant contributions to the management of the trauma victim in different settings and we acknowledge their contributions.


  1. 1.
    Muckart, DJ 1991Trauma—the malignant epidemicS. Afr. Med. J.199395Google Scholar
  2. 2.
    Plaatjie, ST 1916Native Life in South Africa, before and since the European War and the Boer RebellionPS King and SonLondonGoogle Scholar
  3. 3.
    Meli, F 1988South Africa belongs to us. A history of the ANCZimbabwe Publishing HouseHarareGoogle Scholar
  4. 4.
    Nelson Mandela, R 1994Long Walk to Freedom. The autobiography of Nelson Mandela.McDonald PurnellRandburg South AfricaGoogle Scholar
  5. 5.
    Demetriades, D 1986Cardiac wounds. Experience with 70 patientsAnn. Surg.203315317PubMedGoogle Scholar
  6. 6.
    Kaufman,  2003Musket-Ball and Sabre Injuries from the First Half of the Nineteenth CenturyRoyal College of Surgeons of EdinburghEdinburghGoogle Scholar
  7. 7.
    Ryzoff,  1966Selective conservatism in penetrating abdominal traumaSurgery59650653PubMedGoogle Scholar
  8. 8.
    Shaftan, GW 1969Selective conservatism in penetrating abdominal traumaJ Trauma910261028PubMedGoogle Scholar
  9. 9.
    Velmahos, GC, Demetriades, D, Toutouzas, KG,  et al. 2001Selective nonoperative management in 1,856 patients with abdominal gunshot wounds: should routine laparotomy still be the standard of care?Ann. Surg.234395402CrossRefPubMedGoogle Scholar
  10. 10.
    Stein, A, Lissoos, I 1968Selective management of penetrating wounds of the abdomenJ. Trauma810141025PubMedGoogle Scholar
  11. 11.
    Nance, FC, Cohn, I,Jr 1969Surgical judgment in the management of stab wounds of the abdomen: A retrospective and prospective analysis based on a study of 600 stabbed patientsAnn. Surg.170569580PubMedGoogle Scholar
  12. 12.
    Muckart,  1990Selective conservative management of abdominal gunsnot wounds: a prospective studyBr. J. Surg.77652655PubMedGoogle Scholar
  13. 13.
    Demetriades, D, Rabinowitz, B 1984Selective conservative management of penetrating abdominal wounds: a prospective studyBr. J. Surg.719294PubMedGoogle Scholar
  14. 14.
    Demetriades, D, Charalambides, D, Lakhoo, M,  et al. 1991Gunshot wound of the abdomen: role of selective conservative managementBr. J. Surg.78220222PubMedGoogle Scholar
  15. 15.
    Muckart, DJ, Meumann, C, Botha, JB 1995The changing pattern of penetrating torso trauma in KwaZulu/Natal—a clinical and pathological reviewS. Afr. Med. J.8511721174PubMedGoogle Scholar
  16. 16.
    Campbell, NC, Thomson, SR, Muckart, DJ,  et al. 1997Review of 1198 cases of penetrating cardiac traumaBr. J. Surg.8417371740CrossRefPubMedGoogle Scholar
  17. 17.
    Baker, LW, Thomson, SR 1991The current status of the management of civilian injuries to the colonSurg. Ann.23 Pt 1203223Google Scholar
  18. 18.
    Stein, A, Kalk, F 1974Selective conservatism in the management of penetrating wounds of the neckS. Afr. J. Surg.123140PubMedGoogle Scholar
  19. 19.
    Campbell, FC, Robbs, JV 1980Penetrating injuries of the neck: a prospective study of 108 patientsBr. J. Surg.67582586PubMedGoogle Scholar
  20. 20.
    Ngakane, H, Muckart, DJ, Luvuno, FM 1990Penetrating visceral injuries of the neck: results of a conservative management policyBr. J. Surg.77908910PubMedGoogle Scholar
  21. 21.
    Madiba, TE, Muckart, DJ 2003Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?Ann. R. Coll. Surg. Engl.85162166CrossRefPubMedGoogle Scholar
  22. 22.
    Stein, A, Schnier, G 1965Penetrating stab wbunds of the chestS. Afr. Med. J.39548553PubMedGoogle Scholar
  23. 23.
    Muckart, DJ, Luvuno, FM, Baker, LW 1984Penetrating injuries of the pleural cavityThorax397895793PubMedGoogle Scholar
  24. 24.
    Demetriades, D, Rabinowitz, B, Markides, N 1986Indications for thoracotomy in stab injuries of the chest: a prospective study of 543 patientsBr. J. Surg.73888890PubMedGoogle Scholar
  25. 25.
    Hirshberg, A, Thomson, SR, Huizinga, WK 1988Reliability of physical examination in penetrating chest injuriesInjury19407409CrossRefPubMedGoogle Scholar
  26. 26.
    Thomson, SR, Huizinga, WK, Hirshberg, A. 1990Prospective study of the yield of physical examination compared with chest radiography in penetrating thoracic traumaThorax45616619PubMedGoogle Scholar
  27. 27.
    Hirshberg, A, Thomson, SR, Bade, PG,  et al. 1989Pitfalls in the management of penetrating chest traumaAm. J. Surg.157372375CrossRefPubMedGoogle Scholar
  28. 28.
    Huizinga, WK, Baker, LW, Mtshali, ZW 1987Selective management of abdominal and thoracic stab wounds with established peritoneal penetration: the eviscerated omentumAm. J. Surg.153564568CrossRefPubMedGoogle Scholar
  29. 29.
    Demetriades, D, Rabinowitz, B 1987Indications for operation in abdominal stab wounds. A prospective study of 651 patientsAnn. Surg.205129132PubMedGoogle Scholar
  30. 30.
    Whalen, G, Angorn, IB, Robbs, JV 1989The selective management of penetrating wounds of the backJ. Trauma29509511PubMedGoogle Scholar
  31. 31.
    Muckart, DJ, Thomson, SR 1991Undetected injuries: a preventable cause of increased morbidity and mortalityAm. J. Surg.162457460CrossRefPubMedGoogle Scholar
  32. 32.
    Madiba, TE, Mokoena, TR 1995Favourable prognosis after surgical drainage of gunshot stab or blunt trauma to the pancreasBr. J. Surg.8212361239PubMedGoogle Scholar
  33. 33.
    Madiba, TE, Haffejee, AA, Singh, B,  et al. 1995Nutritional support in the management of external pancreatic fistulasS. Afr. J. Surg.338184PubMedGoogle Scholar
  34. 34.
    Thomson, SR, Ghimenton, F 2000Pancreaticogastrostomy for trauma: an alternative to distal pancreatectomyInjury31394395CrossRefPubMedGoogle Scholar
  35. 35.
    Breckon, V, Thomson, SR, Hadley, GP 2001Internal drainage of pancreatic pseudocysts in children using an endoscopically-placed stentPediatr. Surg. Int.17621623CrossRefPubMedGoogle Scholar
  36. 36.
    Whalen, GF, Robbs, JV, Baker, LW, Sheik-Gafoor, MH 1987Injuries of the pancreas and duodenum—results of a conservative approachS. Afr. J. Surg.251518PubMedGoogle Scholar
  37. 37.
    Singh, B, Moodley, J, Sheik-Gafoor, MH 2002Conservative management of thoracobiliary fistulaAnn. Thorac. Surg.7310881091CrossRefPubMedGoogle Scholar
  38. 38.
    Angorn, IB 1977segmental dearterialization in penetrating renal traumaBr. J. Surg.645965PubMedGoogle Scholar
  39. 39.
    Angorn, IB 1977A conservative approach to traumatic intrarenal arteriovenous fistulae: experience with 13 casesInjury8290297CrossRefPubMedGoogle Scholar
  40. 40.
    Velmahos, GC, Toutouzas, KG, Vassiliu, P,  et al. 2002A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuriesJ. Trauma53303308PubMedGoogle Scholar
  41. 41.
    Mokoena, T, Abdool—Carrim, AT 1991Haemostasis by angiographic embolisation in exsanguinating haemorrhage from facial arteries. A report of 2 casesS. Afr. Med.80595597Google Scholar
  42. 42.
    Bryer, JV, Nirmul, D, Hadley, GP,  et al. 1977Traumatic haemobilia: case reportsS. Afr. Med. J.52451453PubMedGoogle Scholar
  43. 43.
    Moodley, J, Singh, B, Lalloo, S,  et al. 2001Non-operative management of haemobiliaBr. J. Surg.8810731076CrossRefPubMedGoogle Scholar
  44. 44.
    Naidoo, NM, Corr, PD, Robbs, JV 2000Angiographic embolisation in arterial traumaEur. J. Vasc. Endovasc. Surg.197781CrossRefPubMedGoogle Scholar
  45. 45.
    du Toit, DF, Leith, JG, Strauss, DC,  et al. 2003Endovascular management of traumatic cervicothoracic arteriovenous fistulaBr. J. Surg.9015161521CrossRefPubMedGoogle Scholar
  46. 46.
    Baker, LW, Thomson, SR, Chadwick, SJ 1990Colon wound management and prograde colonic lavage in large bowel traumaBr. J. Surg.77872876PubMedGoogle Scholar
  47. 47.
    Thomson, SR, Baker, A, Baker, LW 1996Prospective audit of multiple penetrating injuries to the colon: further support for primary closureJ. R. Coll. Surg. Edinb.412024PubMedGoogle Scholar
  48. 48.
    Hirshberg, A, Walden, R 1997Damage control for abdominal traumaSurg. Clin. North Am.77813820CrossRefPubMedGoogle Scholar
  49. 49.
    Mattox, KL 1997Introduction, background, and future projections of damage control surgerySurg. Clin. North. Am.77753759CrossRefPubMedGoogle Scholar
  50. 50.
    Losanoff, JE, Richman, BW, Jones, JW 2003Temporary abdominal coverage and abdominal compartment syndromeArch. Surg.138565566CrossRefPubMedGoogle Scholar
  51. 51.
    Suliburk, JW, Ware, DN, Balogh, Z,  et al. 2003Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe traumaJ. Trauma5511551160PubMedCrossRefGoogle Scholar
  52. 52.
    Demetriades, D, Velmahos, G 2003Technology-driven triage of abdominal trauma: the emerging era of nonoperative managementAnnu. Rev. Med.54115CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  • D. L. Clarke
    • 1
  • S. R. Thomson
    • 1
    Email author
  • T. E. Madiba
    • 1
  • D. J. J. Muckart
    • 1
  1. 1.Department of General Surgery, Nelson R. Mandela School of MedicineUniversity Of Kwa-Zulu NatalSouth Africa

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